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RENDERING A DISABLED PERSON FIT. 



AN ACT OF CONGRESS, generally known as the industrial reha- 
bilitation act, provides for the promotion of vocational rehabili- 
tation of persons injured in industry or otherwise, and for their 
return to civil employment. Under section 2 rehabilitation is defined 
as " the rendering of a person disabled lit to engage in a remunerative 
occupation," The language of the act seems to indicate that its framers 
conceived this definition as almost wholly an educational process. 

The experience of the Industrial Rehabilitation Division of the Fed- 
eral Board for Vocational Education, charged with the administration 
of the act, in cooperating with States active in the work, as well as a 
study of the experiences of agencies operating under private auspices, 
demonstrates beyond question that the rehabilitation of persons dis- 
abled in industry requires many activities besides those of training for 
suitable occupations. " Rendering a person disabled fit to engage in a 
remunerative occupation " is now conceived as a complex specialized 
personal service which may take one or more of the following forms: 

(1) Service leading to physical reconstruction enabling the person to 
return to his former occupation or to enter a new one, 

(2) Service leading to the supplying of a prosthetic or special me- 
chanical appliance and instruction in its use, enabling the person to 
return to his former occupation or to enter a new one. 

(3) Service providing persons having certain disease tendencies 
with working conditions or work favorable to the maintenance of 
health. 

(4) Service providing the disabled person with an opportunity to 
establish himself in business or in industry in independent employment. 

(5) Service providing suitable placement for the disabled person not 
susceptible of formal training, 

(6) Service providing suitable training for a specific occupation. 

In actual practice rehabilitation frequently consists of a combination 
of two or even more of the foregoing services. Closely correlated with 
each of these types of service and offered always in connection with 
all of them is a general service of cooperation, advisement, guidance, 
and follow-up. Without this service none of the others are possible of 
application. The disabled person should, however, be made to feel that 
he has a voice in all decisions concerning the plans for his own reha- 
bilitation. Tactful methods by the rehabilitation agent lead him to feel 
that he makes the decisions, when in reality he is made receptive of 
advice and guidance. This service keeps the person in complete sym- 
pathy with every step in the process of rehabilitation. If a receptive 
attitude and willingness to be advised are not set up rehabilitation in 
any case is likely to fail. 

The, following statements are intended to develop the six forms of 
rehabilitation service given above: 

1)9244—21 



MAJOR SERVICES IN REHABILITATION. 

1. Physical reconstruction.^ — So many persons applying for vocational 
rehabilitation have disabilities that may be either wholly or partially 
corrected by medical or surgical measures that every effort should be 
made to discover whether the maximum physical restoration has been 
attained, even though the disability is of many years' standing. Persons 
who are disabled by stiff or limited joints, fractures with deformities, 
tendon adhesions, nerve injuries, and loss of function of groups of 
muscles resulting from infantile paralysis or other causes will be far 
better served by being put in the way of physical reconstruction (if this 
is possible) than by being trained around their disabilities. No argu- 
ment is needed to prove that to restore the physical condition and ca- 
pacity of the disabled person is a higher and more efficient type of 
service than to prepare him for a new occupation without such meas- 
ures. If the rehabilitation service is to render any assistance at all its 
first obligation is to determine the possibility of physical rehabilitation, 
and no effort should be spared to assist the person to secure the best of 
medical or surgical treatment. 

2. Mechanical appliances. — In most cases of amputation, the applica- 
tion of prosthetic or special mechanical appliances is the first requisite 
to successful rehabilitation. This is true whether the person is returned 
to his former occupation or is prepared to engage in a new one. It is 
not uncommon for persons engaged even in heavy manual labor, such 
as coal mining, to return to the occupation in which they sustained an 
injury resulting in a leg amputation. The only feasible plan of rehabili- 
tation in the recent case of a man of 50 years of age, with a double leg 
amputation below the knees, in view of his limited education, his in- 
ability to profit by a course of training, and his disinclination to enter 
a new employment, was to provide artificial legs so that he might again 
engage in the only work he knew, that of driving a delivery wagon. On 
the other hand, even in cases where the person is trained for an occupa- 
tion in which the lost member is not actually used in the particular 
processes involved, there are other reasons why prostheses should be 
supplied. There are few employments in which an artificial arm or 
leg is not of at least an indirect use. 

3. Favorable working conditions. — In cases of arrested tuberculosis, 
compensating heart trouble, and other similar conditions, the main- 
tenance of health depends largely upon suitable work or working con- 
ditions. In these cases the rehabilitation service must find employment 
where such working conditions exist, or make recommendations to the 
plant surgeon, the health officer, or other authority, that suitable arrange- 
ments be made in the plant in which the person expects to secure em- 
ployment. For instance, the removal of the salvage department of a 
large manufacturing concern from the main building to a detached open 
shed, in the interest of workers with arrested tuberculosis, was a form 
of rehabilitation service. 

4. Independent employment. — In a number of cases the rehabilitation 
service is instrumental in furnishing opportunity for the disabled person 
to establish himself in a business or an industry, not as a worker but 
rather as a foreman, manager, or proprietor. In such event his knowl- 
edge of and experience in a particular line of work is capitalized to the 
greatest extent. This kind of service is illustrated in the case of a man 
•who suffered a left-hand...aDiRutation which p reven ted his return as a 

LI Binary of CONGfTESS I 

*' '. "RECEIVED I 



>vorker to an establishment manufacturing imitation leather lunch 
boxes, suit cases, etc. The rehabilitation service advised the Industrial 
Accident Commission that the monthly payments of compensation 
which the man was receiving should be commuted to the payment of a 
lump sum for the purpose of providing capital to set him up in his own 
business in the line with which he was thoroughly familiar. This was 
done and the man is now successfully operating his own factory. 

5. Suitable placement. — Persons engaged in rehabilitation service find 
that a large percentage of potential cases are not susceptible of formal 
training. Service for these becomes, therefore, direct placement in an 
occupation in which the handicap will not materially affect the produc- 
tion or service of the worker. This function of placement, however, 
embraces much more than the services ordinarily rendered by an em- 
ployment bureau. It furnishes assistance that will make it possible for 
the handicapped person to adjust himself to new and strange working 
conditions, often a difficult process because of his disability. 

6. Suitable training. — When the process of rehabilitation requires a 
training program it may take the form of what is known as employment 
training (placement training, or training on the job), or of training in 
an institution. At times these two forms are combined, but in all cases 
the instruction given is for some specific job objective. If the appli- 
cant has a sufficient background of education and a capacity to profit 
by a course of instruction, then his case from the standpoint of training 
is not difficult, and the service offered usually leads to success. 

The experience of those who are engaged in industrial rehabilitation 
shows that victims of accidents naturally fall into two groups. The 
smaller group consists of those who by their own ambition, energy, and 
integrity rehabilitate themselves. These do not come to the public re- 
habilitation service for assistance. The other group who do apply for 
assistance are for the most part those who, because of age, disinclination 
to apply themselves, lack of determination, ambition, ability to study, or 
capacity to profit by a course of instruction, must be rehabilitated by a 
plan, in most cases, embracing little or no formal instruction. "Within 
this larger group, however, are found at times individuals who because 
of unfavorable circumstances or lack of opportunity have been unable 
to locate in the vocation for which they are best suited by natural quali- 
fications or innate talent. With such persons the agents of industrial re- 
habilitation have many opportunities for skillful guidance. A large pro- 
portion of these are capable of profiting by formal courses of instruction 
and are frequently elevated considerably in the plane of employment 
when placement is found for them. 

FIRST PRINCIPLES. 

One of the first principles in vocation rehabilitation, provided the 
person had been satisfactorily employed at the time of injury or onset 
of disease, is that he be returned, if possible, to the same occupation. 
In most cases this makes for the efficiency, satisfaction, and happiness 
of the person because of his being returned to employment and employ- 
ment conditions with which he is familiar. The first question then 
should always be, Is physical reconstruction possible? If not, can pros- 
thetic or mechanical appliances be provided for the purpose of restor- 
ing the lost functions? .t^^" 



The next consideration is so to place or train the disabled person that 
he will be enabled to compete with able-bodied workers in the selected 
field. Those who render this service must have an extensive knowledge 
of occupational opportunities in the territories in which they work. 
Such knowledge can be secured only as a result of continuous studies 
and investigations of employments and employment conditions, 

MINOR SERVICES. • 

Disabled persons can not be rehabilitated in groups. Because of vary- 
ing' degrees of disability, education, capacity, age, energy, spirit, deter- 
mination, etc., each case presents its own problems and difficulties and 
requires its own specific solution. The -whole VN'ork is organized on what 
is known as the case method. The disabled person is interviewed for 
the purpose of securing a complete inventory regarding his disability, 
education, occupational experience, capacities, personality, financial 
resources, attitude toward rehabilitation, and his desires concerning re- 
turn to employment. All these conditions are thoroughly studied for 
the purpose of developing the best solution of the problem of rehabili- 
tation. 

The purpose of the foregoing statements is to describe the varieties 
of service required in any program of rehabilitation. These activities 
are its major functions, but there are many other phases of the work, 
usually considered minor functions, which at times become matters of 
great importance. Among these are the problems of maintenance for 
the disabled person while he is undergoing rehabilitation, travel to and 
from the place of training, support and maintenance of his dependents, 
etc. Most public agencies conducting rehabilitation service are pre- 
vented by legislation from supplying financial assistance for main- 
tenance, prosthetic appliances, and travel, but it becomes their business 
none the less to see that these are provided if rehabilitation in particu- 
lar cases is to be effected. These supplemental or minor functions may 
be likened to the scaffolding which is necessary to the construction of 
a building. Without the scaffolding the erection of the building would 
be impossible. So, without the interest, assistance, and cooperation of 
other agencies, organizations, or individuals, rehabilitation is impossible. 

SCHOOL TRAINING. 

In conclusion it is evident that formal educational programs in the 
majority of cases are a secondary phase in the service of industrial re- 
habilitation. A young woman, with double amputation of the legs above 
the knees, who was trained to retouch photographic negatives, is now 
as effective a worker as others in the same line of work who suffer no 
physical disability. In this case providing a suitable wheel chair, a 
course of instruction in an art school, and placement in a photographic 
establishment was real rehabilitation service. On the other hand, a 
young man who lost a leg and arm needed onl}^ the loan of some capital 
to make him a successful merchant in a retail business. In this case 
discovering a person able to finance the project, securing his willingness 
to make the loan, and helping the disabled person to set up his own 
business, although requiring no educational program, was nevertheless 
a high type of rehabilitation service. — Reprint of an article by John 
Aubel Kratz in " The Vocational Summary," July, 1921, published by the 
Federal Board for Vocational Education, Washington, D. C. 

WASHINGTON : GOVERNMENT PRINTING OFFICE : 192i 



